Bailey N. Boltz, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA61101539 Issued in WA

Practice address

3801 5TH St SE Ste 110
Puyallup, WA 98374-2106

Phone

(253) 845-9585

NPI assigned

Nov 7, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Bailey N. Mantha-Nagrant Former name

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Multicare Good Samaritan Hospital Hospital, Puyallup, WA, CCN 500079

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bailey.manthanagrant.p83@direct.proliance.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Proliance Surgeons Inc P S

  dba Proliance Surgeons Orthopedic Specialists of Seattle

  • Orthopaedic Surgery Physician
  • Seattle, WA
  • NPI 1023170313
  Medicare reassignment Care Compare group
• Proliance Surgeons Inc P S

  dba Proliance Orthopedic Associates

  • Orthopaedic Surgery Physician
  • Renton, WA
  • NPI 1235091463

  Surgical

  NPD
• Proliance Surgeons, Inc., P.S.

  dba Proliance Puyallup Surgeons

  • Surgery Physician
  • Puyallup, WA
  • NPI 1255736971
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Multicare Health System

  dba MultiCare Good Samaritan Hospital

  • General Acute Care Hospital
  • Puyallup, WA
  • NPI 1841231461
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1831790591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 5TH ST SE STE 110",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983742106",
            "telephone_number": "253-845-9585",
            "fax_number": "253-848-1126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 5TH ST SE STE 110",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983742106",
            "telephone_number": "253-845-9585"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20920 SR 410 E",
            "address_purpose": "LOCATION",
            "city": "Bonney Lake",
            "state": "WA",
            "postal_code": "983916302",
            "country_code": "US",
            "telephone_number": "253-845-9585",
            "fax_number": "253-848-1126",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLTZ",
        "first_name": "BAILEY",
        "middle_name": "N.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-07",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61101539",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA61101539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2171601",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BAILEY",
            "last_name": "MANTHA-NAGRANT",
            "middle_name": "N.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alice L Bohlman, RN
• Margaret Boland
• Karen Bolanoz-Lopez
• Dametra Lynthia Bolar
• Marilyn Bollinger
• Kelly Bonavena, L.AC, MSOM
• Bonaventure of Puyallup
• Holly Anne Bonnardel, LMFTA
• Nicole Malene Bosch
• Sylvia E Boskovich III

• Surgical Physician Assistant in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Surgical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.